Specialised Unit in Implantation Failure and Recurrent Miscarriage

Specialised Unit inImplantation Failure andRecurrent Miscarriage

Study of the Immune Factor

Different solutions for different situations

At Ginemed’s Specialised Unit in Implantation Failure and Recurrent Miscarriage we are dedicated to finding the solution to complex cases involving previous implantation failure, rare pathologies and undiagnosed cases (‘’unexplained infertility‘’) which have resulted in undesired outcomes.

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The medical team who will treat you is specialised in these types of cases and is exclusively dedicated to offering a unique solution for your particular case. For this reason, it is often necessary to undergo alternative pre-treatment testing adapted on a case-by-case basis. These studies differ from the medical tests ordered in a typical reproduction study in which they would normally be unnecessary. When dealing with cases of previous implantation failure, however, alternative testing is essential to understanding the cause behind the underlying problem in order to find a solution.

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Dr. Juan Manuel Jiménez

Reproduction Specialist

Ginemed

Phases of the Process

1º

Case Study

2º

Diagnosis

3º

Approach treatment from a multidisciplinary point-of-view

Who are the High Complexity Case Consultations intended for?

Implantation Failure

Patients who have transferred a minimum of 4 good quality embryos over the course of at least 3 embryo transfers, with at least one being the transfer of a blastocyst embryo.

Recurrent Miscarriage.

Patients who have had 3 consecutive miscarriages or who have been diagnosed with a condition following a second miscarriage.

Unexplained Infertility

Patients whose infertility has no known cause after having undergone the Basic Infertility Study.

Frequently Asked Questions

What role do immune factors play in reproduction?

We often have good quality, healthy embryos, but in spite of this we are unable to obtain a viable pregnancy (cases of repeated implantation failure), or we obtain a pregnancy but it does not progress (cases of recurrent miscarriage). Although not always the case, there are often underlying immune problems which prevent the mother from accepting the embryo.

Immunology is one of the physiological pillars essential to achieving a pregnancy, as the success of a pregnancy depends on correct immune balance.

Pregnancy is a challenge and an immunological paradox for the mother, as her immune system must allow a semiallogeneic embryo to implant (an embryo that shares 50% of her genetic material) or even an allogeneic embryo to implant (100% of the embryo’s genetic material is different from the mother’s). According to the laws of transplantation immunology, the mother should reject this different genetic material. However, under normal conditions embryo implantation is tolerated.

What role do immune factors play in reproduction?

Why is my immune system rejecting my embryos?

The necessary immune tolerance processes which prevent the mother from rejecting the embryo are extremely complex, and at present we do not even understand all the mechanisms which allow for normal implantation and development of the embryo inside the mother’s womb.

Immune system tolerance or rejection conditions implantation. In reproductive immunology we strive to pinpoint the factors involved in the early stages of pregnancy so that we can adjust them as necessary to offer personalised solutions on a case-by-case basis.

What happens when the immune system fails?

Several groups around the world are studying these processes of tolerance and rejection, as well as how changes in the immune system make it possible for abnormal embryos to implant but to later end in miscarriage, or how they prevent genetically healthy embryos from implanting.

We also study whether interaction between the mother and the embryo is correct or not, as this can lead to gestations that stop developing before they can be seen with an ultrasound (chemical pregnancy) or after they’ve already been seen on an ultrasound (anembryonic gestation – blighted ovum - or delayed miscarriages).

New studies are showing the relationship between implantation issues and pregnancy conditions such as pre-eclampsia or intrauterine growth restrictions.

What happens when the immune system fails?

How can reproductive medicine change this?

Several types of immune cells have been identified at the maternal-foetal interface, including Uterine Natural Killer (uNK) cells (70%), macrophages (20%), T lymphocytes (10%), dendritic cells and B lymphocytes (very few). The number of cells present and the role they play change throughout the different stages of pregnancy.

NK cells are the lymphocytes which have the greatest impact on maternal-foetal tolerance. NK cell function is regulated by a series of receptors that produce different signals. Among the NK cell receptors identified is a family of receptors similar to immunoglobulin (KIRs); these receptors bind to proteins such as HLA-C (C-class histocompatibility antigens).

HLA is one of the identification systems the body uses to recognise its own materials and protect itself from foreign materials. Both KIRs and HLA-C are polymorphic and certain combinations could negatively impact the success of a pregnancy. Several promising lines of research are investigating the very likely impact of HLA-G, HLADQ and E systems on achieving a pregnancy.

What specific studies are ordered in cases of Implantation Failure and Recurrent Miscarriage?

Personalised treatment plans are essential in cases of implantation failure and recurrent miscarriage. For this reason, the studies and tests ordered by the doctor will depend on each patient’s personal and family medical history. The main types of studies are:

Immune Studies

Endometrial NK cell study.

Autoantibody and serum immunoglobulin alterations.

Cytokines and Interleukins related to the lymphocyte response. (Th1/Th2 ratio).